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Exclusive: Bye,Bye NHS Direct – chief’s leaked e-mail

Colourful protest against the end of NHS Direct. Pic courtesy:Urban75 blog

The hugely popular NHS Direct service is facing near extinction next year. Health secretary Andrew Lansley’s decision to replace the well-regarded national service with a piecemeal local service run by any English local provider could mean it will be running nothing by the end of next year.

So far despite providing some of the trials for new cheaper NHS 111 phone line in Luton,Nottingham and Lincolnshire, NHS Direct has failed to secure a single contract.

This dire news is contained in a confidential e-mail from Nick Chapman, chief executive of the doomed organisation, which is on the Exaro News website ( http://www.exaronews.com).

It shows with a third of the local areas already choosing their preferred provider for the service NHS Direct has secured the ” preferred provider ” status in just three areas, covering a mere four per cent of the population – Cornwall and the Isles of Scilly, Somerset and one other area. But even this guarantees nothing.

As Mr Chapman says: “No contracts have yet been signed and there is still a lot of work to be done to agree the final contracts before we start delivering the service.”

And where NHS Direct is putting through pilots, these will be up for grabs by anyone else, once the period is over.

So who is getting them? Despite publicity showing that three of the main for profit providers, Care UK, Capita and Serco have pulled out – this has left Harmoni grabbing the biggest share with Hillingdon, Croydon, Wandsworth, Suffolk, parts of Kent and Sussex and Wiltshire and parts of North Somerset, all now to be run for profit. And the promise of a six month delay may merely serve to persuade more private firms to move in – rather than defend the existing state provided service.

The rest has gone to various trusts and social enterprises ( some well run by GPs like in Devon, others not so well run) taking over. NHS Direct is being cautious -saying commercial confidentiality stops them revealing the full picture.

Should we care? According to the BMA we should.

As Dr Laurance Buckman, chairman of the BMA’s GP committee, said: “A potentially dangerous version of NHS 111 is set to burst forth upon an unsuspecting public from April. Patients may end up being sent to the wrong place, waiting longer, blocking A&E and using ambulances needlessly, when a little more consideration might make it all work properly.”

Of course ministers like Simon Burns say it is fine and good value for the taxpayer. But I wonder if the public will like it – particularly if it to be mainly staffed by people with just 90 days training – rather than nurses who might have a better knowledge of medical matters. One wonders whether like a recent call I made to Blackberry, the centre will be spending their time looking up articles on Google to provide the best advice . Very worrying if you are an anxious mother or have a sick child.

The priavtisation of NHS Direct is the biggerst privatisation of the NHS that anyone was made. Put this alongside the running of hospitals that is moving forward by so called ‘not for profit’ organisations and perhaps others shows the true path of the Tories and the lies that the NHS is safe in their hands.

It’s important to be clear about the role of Lansley and the Coalition government in this development. The 111 pilots in the regions you mention have been running for years now, long before the Coalition were formed. The idea was always that if the pilots were a success the 111 service would go national. This development is, if anything, a confirmation of the success of a project launched whilst Labour were in power.

Paul. You miss the point. Same scheme, different contract arrangements.

I agree with a lot you say. Yes this was conceived under Labour, Yes they thought it was too expensive, Yes they were the ones to redcue the number of nurses etc. NHSD staff were working on this for at least a year in not two before the pilots started (not altogether with enthusiasm for the outcomes), but the pilots where started with only months before the election and the contract that people are now signing up to is a Tory dominated DH and is clearly going to lead to NHSD not getting many sites if any in the long term.

As far as your comment about NHSD’s performance is concerned, monthly survey demonstrated around 95% of people who used the service liked it and that is a high proportion for call centre operations. The complaints we dealt with were greatly reduced and none in the last six years have had to be investigated by the Ombudsman. If you look at the current comments on Linked In about the pilots with stories of 10% more admissions to hospitals, 33% more OOH referrals and A&E attendances with some reporting even more in the pilot area’s, even those doctors who used to criticise NHSD are now complaining of the increases in referrals on.

Why are the DH not publicising the pilot details, why is it having to be leaked. I asked the DH for the costs and they said they didn’t know. I have their email telling me I’d have to ask each individual site!!!!

I would like to see the studies into 111 piltots but it seems these are not going to be released. The comments on systems linked Linked In then are all we can judge by and those are not at all supportive.

We’re into the realm of anecdotal evidence here, though, which is always open to debate. I don’t dispute the caller satisfaction survey results (which have been mirrored in the 111 environments) – the point I was making related to historic grumblings from front line ambulance workers, OOH staff etc. With any telephone triage service there is *always* a perception in the wider NHS that they over-refer patients.

I cannot comment on the DH or what their reasons are for the information they do or do not release but from what I can gather, within a few months of the pilots launching the referral rates to the wider NHS were an improvement on what had gone on previously. The increased hospital admissions, OOH referrals etc. that you refer to are simply not true based on what I’ve seen and from conversations I’ve had with local commissioners. Again I can only assume that there is a degree of anecdotal evidence there which may possibly relate back to early concerns when the pilots were first launched and results took a few months to settle.

Hi David. Yes the NHSD system did attract a lot of comments from ambulance services and doctors, OOH, Practice and A&E’s. But once a system is embedding inside another system any evidence of improved practioce that was present at the start of the system quickly disappears as your base line has moved and you no longer have a level playing field (as the term is). For instance NHSD was tasked with targetting the elderly, young men, ethnic minorities and mothers of young children, which it did very well and more of these types of patients came into the service as a result, probably negating the early gains we were showing from the service in the early days. I know one Ambuilance Manager who used to go to events talking about NHS Redirect. However his service was one of the first to use NHS Direct to deal with Cat A calls, reducing their workload effectively. It is these types of remarks that got the DH moving against NHSD.

As far as figures are concerned the only ones that are being published are the unofficial ones from the pilots. One new leak from the North only two or three weeks ago stated a large increase in the number of admissions and you are the first person I have seen to refute this. There needs to be more if it is to be believed about all the sites and there needs to be a new Sheffield study or something.

The concept of “profit” being only a bi-product of 111 is somewhat misleading too. I would be curious to see just how much money the American company Clinical Solutions has made during the time NHS Direct has existed.

Yes the 111 pilots were running a few months before the coalition came to power (not years – I was there). But all the pilots were run by NHS organisations with Doctors Co-operative partaking. The people who wrote the contract for the roll out did so under the coalition.

Clinical Solutions gained the NHSD contract on fair competition and they are a commercial company selling software just like any other. Of course they make profit as do any other commerical supplier of bandages, beds, bricks and concrete.

As for profit and 111. It is estimated that a doctors commercial out of hours service will gain most of the 111 services at the moment. As it is run as a private company they will be looking for profit like any other commercial company. It may be a by product but it is selling off the NHS to the private sector and therefore privatisation

The first 111 pilots started taking calls in the north east/east midlands/luton in Autumn 2009 – coincidentally I was there too. And as you will no doubt be aware, major pilots like this do not just spring up overnight. They were months & years in development and were very much a Department of Health initiative under the Labour government.

I have no axe to grind with any political party in this instance, but I do find it irritating when Labour MPs speak out about this when, fundamentally, it is the same project that was first conceived in 2007/08.

With regard to NHS Direct, there is an awful lot of independent evidence (again going back well before 2010) to suggest that it was fundamentally flawed with regard to how much money it was costing the NHS in relation to the service it was providing. Whilst I would agree that a complete abolition of the NHSD service would be a bad mistake, having seen how well the pilots have worked I am quite confident that 111 will surprise a lot of people in terms of how well it works.

What on earth is this sell-off doing for job security for health professionals. Nurses are “too expensive” to staff NHS direct so not re-employed, contracts are re-negotiated, and up for grabs to any other under-cutting provider, annually (at least at the moment). Not only does that cause havoc with continuity of service provision but it leaves ex-NHS employees forced to work for the private sector in precarious positions (worried about our jobs so very cautious about what we spend in the economy). I do wonder how many of the coalition grasp the concepts of efficiency & logic